Key takeaway
When a parent misuses alcohol or drugs, other people in the house often change what they do so the week still runs. SAMHSA's TIP 39 describes five patterns counselors may notice, including the hero, the lost child, and the scapegoat. The same manual says to meet families with empathy, not blame. The patterns are not diagnoses.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You may have been the one who paid the bills, the one nobody asked about, or the one who got blamed when a parent was using. That job can feel like a personality. SAMHSA's TIP 39, updated in 2020, treats it as a shift the family made so the week would still function. Families try to keep homeostasis, the manual's word for balance. Chapter 1 says members assume roles related to generation, culture, beliefs, gender, and how the family is functioning. Some roles develop because of stress or because one person is underfunctioning. The addiction field has long used role ideas to help families see how they adjusted. Roles can hold a family steady. They can also hurt the person stuck in the role, or pull attention away from the substance use. The example in that chapter is a family that treats a child as the cause of its problems when one or both parents have a significant substance use disorder.
The key messages in chapter 2 ask providers to remember the rest. Dysfunctional patterns often appear while a family struggles to keep life normal. Members are usually doing their best. Ways of coping can still be unhealthy. Approach families with empathy and understanding, not judgment and blame. The exhibit SAMHSA printed for counselors is a way to notice those patterns. It is not an invitation to sort relatives into boxes and leave them there.
If a child is being hurt, or anyone is in immediate danger, call 911. If you are in a mental health crisis, call or text 988.
What the exhibit actually lists
Exhibit 2.4 is titled "Family Roles When a Parent Has an SUD." It says that when a parent misuses substances, it is common for children to take on certain roles. The roles are determined in part by the child's personality and innate features, and they are designed to help the family keep its balance. The literature often discusses them for spouses and young children. The exhibit says they apply to adult children as well. Counselors are told to notice whether spouses and children, young or grown, are falling into the roles and how that affects unhealthy dynamics.
The descriptions are short. They are patterns, not medical conditions.
The enabler protects the person from the negative effects of substance misuse, may handle those effects in order to protect them, and may spend little time on their own needs while caring for the person with the disorder.
The family hero is often the older child. The focus is responsibility and taking care of the person with the substance use disorder. The hero may feel overwhelmed, as if the whole family is relying on them.
The lost child has needs and wants the rest of the family overlooks. Achievements may go unrecognized. That child may live in a separate world, feel lonely and sad, and have few close relationships.
The mascot distracts the family from the substance use disorder, often with humor, charm, or by being the life of the party. Avoiding conflict is common. As an adult, that avoidance may make problems and healthy relationships harder. Other people in the family may not take the mascot seriously, and expectations may be low.
The scapegoat draws attention away from the family member with the substance use disorder by getting into trouble or by other harmful patterns. The exhibit says this child may be likely to misuse substances or spend time with friends who do, and may be at risk for later legal, school, and work problems.
SAMHSA cites Vernig (2011) and Wegscheider-Cruse (1989) as the sources of the exhibit. Those citations are the manual's, not extra traits added here. If a popular article lists a quality the exhibit does not, leave that quality out.
Names, blame, and the child who grew up too soon
There is a tension inside the same TIP, and it is worth saying plainly. The exhibit uses the name "enabler." The front of the manual tells counselors to avoid judgmental labels, and it names "enablers" as one to avoid. The codependency guide walks through that warning and through enabling as behavior. You can describe protection, overwork, disappearance, joking, or trouble-making without turning a person into the label. TIP 39 also says that using labels to confront each other leads to conflict. "You are the scapegoat" is not an intervention the manual recommends for the dinner table.
A related pattern is not one of the five names. Chapter 2 says substance misuse can lead to inappropriate roles. In one example, a young child is expected to take the role of mother while the mother is using. When a child takes adult roles and the adult takes the role of a child, boundaries blur. The manual says that developmentally inappropriate role robs a child of a childhood unless healthy, supportive adults intervene. A spouse often protects the children and picks up parenting the other parent is not doing. If both parents are misusing alcohol or using illicit drugs, the effect on children worsens. Extended family, and often grandparents, may provide care. The parenting guide speaks to the parent in recovery. The boundaries guide covers those blurred lines. The teen treatment guide covers the level of care when the young person needs services of their own.
Children in this situation may feel guilty and responsible for a parent's substance use and for finding treatment. That sentence is in TIP 39, citing other research. Guilt in a child is not evidence that the child caused the disorder. The manual's stance remains non-blaming: the family was coping.
The same chapter says positive outcomes are possible. A review it summarizes found resiliency and, for some children, reduced risk of substance misuse, especially with protective factors such as secure attachment, several ways of coping, parental support, family cohesion, lower parent-related stress, and social support for the child. Those are findings about groups. They are not a score for one household, and they do not erase harm.
Adult children may still carry the old organization. TIP 39 says they may feel angry or resentful, may have trouble with trust and with close relationships, and may ignore their own needs to care for others. Unhealthy patterns from childhood, including enabling, can continue after the children are grown. The adult-children guide speaks to the grown person, including the mutual-help fellowship. The account here stays with the exhibit. The forgiveness guide covers making peace later, including the choice not to reconcile with someone who is unsafe. Anger that includes threats is an emergency, not a role discussion. Use the number above.
Where a family can take the pattern
Family counseling, in TIP 39, can look at roles, communication, and the ways members respond to substance use. It is a clinical service. The family therapy guide covers who may attend, who decides, and when a session should not happen, including current abuse and intimate partner violence. The family support guide speaks to relatives who want help whether or not the person with the substance use disorder joins them. The guide for families whose relative does not want help stays on that narrower question.
You do not need to announce a role before you ask a program what it offers families. FindTreatment.gov lists programs. Calling (800) 653-9376 is a referral conversation about programs that include families, not an assessment of which child was the hero.
Additional Resources
Sources cited on this page:
- SAMHSA TIP 39, Chapter 2: Influence of Substance Misuse on Families (NCBI Bookshelf)
- SAMHSA TIP 39, Chapter 1: Substance Use Disorder Treatment: Working With Families (NCBI Bookshelf)
- SAMHSA TIP 39: Substance Use Disorder Treatment and Family Therapy (2020 update, GovInfo PDF)
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Does every family have a hero and a scapegoat?
No. TIP 39 says it is common for children to take on certain roles when a parent misuses substances, so the family can keep its balance. Common is not universal. The manual says no two families are the same, and family type changes how people cope. An exhibit is a teaching tool for counselors. It is not a seating chart your household must match.
Are these roles a diagnosis?
No. The exhibit describes patterns some spouses, children, and adult children fall into. It does not list them as disorders. TIP 39 separately tells counselors to avoid judgmental labels. You can recognize a pattern without pinning a title on a brother or a parent. The codependency page explains why SAMHSA also warns against the word codependent.
Is a child to blame for the role they took?
TIP 39 says family members are usually doing their best to cope, and that ways of keeping balance can still be unhealthy. Roles are described as a response that helps the family hold steady, shaped in part by the child's personality. A child who became the responsible one, or the one who got in trouble, was adapting. The manual's instruction is empathy, not blame.
Do the roles end when the parent gets help?
TIP 39 does not promise that. It says the same patterns can show up among adult children, not only among young children, and that roles can harm the person in them or distract the family from the substance use. Family counseling is one place those patterns can be worked on, when it is safe and the person in treatment wants it. A chart cannot schedule that change for your household.
Should I tell my family which role they are?
The exhibit is written for counselors, so they can notice dynamics, not so relatives can label one another at dinner. TIP 39 says labels and name-calling raise conflict. If the pattern is hurting people, the family therapy guide explains the clinical service and its safety limits. If a child is in danger, call 911.